The Four Healthcare Categories
Posted by Rainbow6 on January 5th, 2011Is it time to choose the right healthcare insurance coverage? You are wise to begin your decision with proper research! Don’t get a poor coverage by making a rapid decision.
This article will undoubtedly aid you with your decision, and will help ensure you get the right coverage given your health and wallet. Firstly, determine your budget as well as your needs. The cost of healthcare continues to rise annually, at the same time, people live longer, it’s vital to obtain proper health coverage.
There’s essentially just four main coverage options. They are: Major Medical, HMO, PPO, and POS.
The Major Medical Coverage:
A lot of people are covered by this plan. The insured pays ahead of any medical expenses in a form of a monthly deductible. When the time calls for it, the insured party can seek the aid of any medical facility they want, employ their services and directly pay them. Then after providing the insurance company with a claim, their costs will be partially reimbursed. Alternatively the insured individual can opt to sign a release, to have the insurance provider pay the healthcare provider directly. With every system, the coverage falls short of 100%.
Another popular option is the Health Maintenance Organization (HMO):
Unlike the Major Medical plan, the HMO offers a slightly different approach. It is typically cheaper, but with that reduction in price come limitations. The plan member has to choose a medical practitioner to go to. It is that physician’s task to provide preventive healthcare and coordinate treatment with any specialists that too are in that network (and even hospitalization whenever necessary). If it happens that the practitioner is not in the network, they will not be covered. Those procedures and treatments that are determined unnecessary will not be covered.
Third is the Preferred Provider Organization (PPO):
You can think of this as something midway between Major Medical and HMO. With PPO the insured member has the choice to choose any medical professional to provide treatments, but a list of predetermined physicians is also provided. As a result the costs decrease. The deductibles to the insured person are lowered when the members choose on care from a doctor on that network. Coverage of treatment is still reimbursed, to 80% of the cost of the treatment. But to 80% of the cost that was determined by a respective specialist that is in the network. That is, it’s not 80% of the cost, but of the acceptable cost. This too tends to be higher.
Fourth kind is Point Of Service (POS):
To balance cost and coverage; a midpoint between a HMO and a PPO plan; there is POS. Some freedom is retained, while the management of costs is improved on the insurer’s end. The plan holder has to decide on medical practitioner and all healthcare from that point onwards must be initiated by that physician. The doctor may refer the plan holder to a specialist that may or may not be of the predetermined network of specialists. In such a case, unlike the HMO, even if the doctor is outside of the network, the medical expenses will still be subsidized to a certain extent. However if there was no referral, then the insurance company may not cover those costs.
Tags: Healthcare
